Surgery for Large Hiatus Hernia

A large hiatus hernia is a type of hernia that occurs when the stomach bulges up into the chest through an opening in the diaphragm, known as the esophageal hiatus. Surgery is often necessary to repair the hernia and alleviate symptoms such as heartburn, regurgitation, and difficulty swallowing.

Types of Surgery

There are several types of surgery that can be used to repair a large hiatus hernia, including:

• Laparoscopic Hiatal Hernia Repair: This is a minimally invasive procedure where several small incisions are made in the abdomen and a laparoscope (a thin tube with a camera) is inserted to visualize the hernia. The surgeon then uses specialized instruments to repair the hernia.
• Open Hiatal Hernia Repair: This is a traditional open surgery where a single large incision is made in the abdomen to access the hernia. The surgeon then repairs the hernia using sutures or mesh.
• Robotic Hiatal Hernia Repair: This is a type of minimally invasive surgery that uses a robotic system to assist the surgeon during the procedure. The robot provides high-definition visualization and precise instrumentation, allowing for more complex repairs.

Surgical Techniques

During surgery, the following techniques may be used:

• Hiatoplasty: This involves repairing the esophageal hiatus by suturing or using mesh to reinforce the opening.
• Gastropexy: This involves attaching the stomach to the abdominal wall to prevent it from bulging up into the chest.
• Crural repair: This involves repairing the crura, which are the muscles that surround the esophageal hiatus.
• Mesh placement: This involves placing a mesh material over the hernia to reinforce the repair and prevent recurrence.

Risks and Complications

As with any surgery, there are risks and complications associated with large hiatus hernia repair, including:

• Bleeding or hemorrhage
• Infection
• Adhesions or scar tissue formation
• Respiratory complications, such as pneumonia or respiratory failure
• Cardiac complications, such as heart attack or stroke
• Dysphagia (difficulty swallowing)
• Recurrence of the hernia

Recovery and Follow-up

After surgery, patients typically spend several days in the hospital recovering. The following are general guidelines for recovery and follow-up:

• Pain management: Patients may experience pain or discomfort after surgery, which can be managed with medication.
• Dietary restrictions: Patients may need to follow a liquid or soft food diet for several weeks after surgery to allow the stomach and esophagus to heal.
• Follow-up appointments: Patients will need to schedule follow-up appointments with their surgeon to monitor their progress and remove any sutures or staples.
• Lifestyle modifications: Patients may need to make lifestyle changes, such as avoiding heavy lifting or bending, to prevent recurrence of the hernia.

Outcomes and Prognosis

The outcomes and prognosis for large hiatus hernia repair are generally good, with most patients experiencing significant improvement in symptoms. However, the success of the surgery depends on various factors, including:

• SIZE and location of the hernia
• Presence of underlying medical conditions, such as gastroesophageal reflux disease (GERD)
• Overall health and fitness of the patient
• Experience and skill of the surgeon

It is essential to discuss the potential outcomes and prognosis with a qualified healthcare professional to determine the best course of treatment for a large hiatus hernia.